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Peds Exam 1 > Cardio > Flashcards

Cardio Flashcards

1
Q

Fetal Circulation Structures

A
  • 1 umbilical vein
  • 2 umbilical arteries
  • foramen ovale
  • ductus arteriosus
  • ductus venosus
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2
Q

When umbilical cord is cut…

A

immediate increase in systemic vascular resistance

  • increases blood and pressure in LA and LV causing foramen ovale to close
  • ductus arteriosis constricts and closes in 10-15 hours after birth
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3
Q

A&P Pediatric Cardio Differences

A
  • infants have increased metabolic and O2 demands, so HR increases to maintain high cardiac output
  • infants at increased risk for heart failure because heart is more sensitive to fluid overload
  • muscle fibers of heart less developed
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4
Q

Because muscle fibers of heart are less developed…

A
  • decreased compliance (ventricles do not expand well)

- SV cannot increased much

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5
Q

heart fully developed…

A

by age 5

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6
Q

Ventricles at birth..

A

LV and RV same size at birth but by 2 months, LV is twice the size of RB

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7
Q

Systolic BP at adult level by…

A

puberty

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8
Q

CHD Etiology

A
  • defect in heart or great vessels
  • persistance of fetal structure after birth
  • most develop in first 8 weeks of gestation
  • drugs, alcohol, smoke
  • maternal metabolic disorders
  • advanced maternal age, maternal viral infections
  • genetic factors
  • chromosomal abnormalities
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9
Q

Classifications of CHD

A
  • increased pul BF
  • decreased pul BF
  • obstructed systemic BF
  • mix of defects
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10
Q

Defects that cause increased pul BF

A
  • abnormal connection between two sides of heart
  • blood shunts from left to right
  • if untreated, pul overcirculation leads to RV hypertrophy, CHF, pulmonary HTN, and eventually death
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11
Q

Pulmonary HTN

A
  • vicious cycle
  • hole in heart…blood goes from left to right…extra blood to get into the lungs…RV gets bigger due to bigger job
  • pulmonary arteries constrict to try to keep too much blood going into the lungs
  • RV keeps getting stronger and stronger against the pul artery constriction
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12
Q

Clinical Manifestations of increased pul BF

A
  • tires during feed
  • poor weight gain
  • tachypnea, tachycardic
  • murmur
  • CHF
  • diaphoresis
  • periorbital edema
  • freq. resp infections
  • crackles
  • cardiomegaly
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13
Q

PDA

A

Patent ductus arteriosus

  • fetal ductus arteriosus that does not close
  • common in preterm infants
  • blood is shunted from aorta to the PAs and lungs
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14
Q

Tx for PDA

A
  • may close spontaneously
  • IV indomethacin or ibuprofen 10 to 14 days of life
  • equally efficient medications

if does not work…

  • cardiac cath with coils
  • surgical ligation

not open heart, done from the side of chest

prognosis is good

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15
Q

ASD

A
  • small or large opening in atrial septum
  • pressure higher on left side so BF from left to right
  • closure: spontaneous, transcatheter device in cath lab, or surgery age 4 to 5 years
  • prognosis good if ASD is closed
  • untreated adults: CHF, pul HTN, atrial arrhythmias
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16
Q

VSD

A
  • opening in ventricular septum

- increased PVR and RV enlargement with large VSD

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17
Q

clinical therapy for VSD

A

closure

  • small VSDs may close spontaneously
  • surgery, patch
  • closure in cath lab
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18
Q

Prognosis for VSD

A
  • highest risk if repair needed in first few months of life

- good prognosis for older children

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19
Q

AV Canal

A
  • ASD + VSD + valve defects
  • blood moves freely among the 4 chambers
  • associated with down syndrome
  • severity of symptoms depends on degree of mitral valve regurgitation
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20
Q

AV Canal Tx

A
  • surgical, done in infancy

- may need O2 until surgery

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21
Q

Prognosis for Av Cancal

A

-depends on mitral valve insufficiency and arrhythmias are common

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22
Q

PA Band

A

pul-art band

  • done prior to full repair
  • small clip placed on pulmonary artery
  • decrease BF to the lungs
  • give child a chance to grow more and gain some weight
  • not done as freqently now
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23
Q

Nursing Management Pre-op for increased pulmonary BF

A
  • family education

- psychosocial support

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24
Q

Nursing Management Post-op for increased pulmonary BF

A
  • monitor for complications
  • impaired perfusion
  • arrhythmias
  • infections
  • heart sounds
  • pulse ox
  • VS
  • incision site
  • assess resp system
  • pain assessment
  • manage fluid and nutrition
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25
Q

Outcomes of Nursing care

A
  • child’s pain is effectively managed
  • full lung expansion is achieved with spirometry exercises (blowing bubbles) or chest physiotherapy
  • incision heals without infection
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26
Q

Clinical Therapy for CHF

A

goal: make heart work more efficiently and remove excess fluid
- diuretics
- ACE inhibitors
- ionotropics

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27
Q

Diuretics

A

remove accumulated fluid and sodium

-monitor potassium

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28
Q

ACE inhibitors

A

lessen workload of heart by decreasing peripheral vascular resistance

-blood vessels dilate which decreases BP…lessen workload

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29
Q

Ionotropics

A

changes force of heart contraction

positive: strengthen heart contraction
negative: weakens strengthen hear contraction

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30
Q

Digoxin

A

positive ionotropic

  • improves contractility and increases CO
  • powerful, small therapeutic window
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31
Q

hold dig for infant

A

if apical HR less than 100

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32
Q

hold dig for older child

A

hold for HR less than 70

33
Q

before giving digoxin…

A
  • apical HR for one minute
  • potassium level
  • check dig level
34
Q

Beta blockers

A
  • blocking epi and norepi
  • improves cardiac function

“lol”s

-more beneficial effects

35
Q

Oxygen

A

improve tissue oxygenation

36
Q

Defects that decrease pulmonary blood flow

A

aka cyanotic defects

  • little or no blood reaches lungs to get oxygenated
  • causes increased pressure on the right side of the heart, leading to R to L shunting if a septal opening exists
  • polycythemia increases risk for thromboembolism
  • cyanotic episodes with feeding, crying, and exercise
37
Q

TOF

A

tetralogy of fallot

  • four defects: pulm stenosis, right ventricular hypertrophy, VSD, overriding aorta
  • PS impedes the flow of blood to the lungs
  • elevated right heart pressure causes R to L shunt
  • increase workload on the RV causes it to hypertrophy
  • aorta receives blood from both the RV and LV
38
Q

Clinical manifestations of TOF

A

-depends on the size of the PS

  • systolic murmur
  • cyanosis
  • polycythemia
  • poor growth
  • clubbing of fingers and toes
  • exercise intolerance
  • squatting
39
Q

Clinical Therapy of TOF

A

repair: surgical by 6 months of age
- may have B-T shunt first to delay total repair
- management of hypercyanotic episodes

40
Q

Prognosis of TOF

A
  • improved quality of life

- may have arrhythmias and right ventricular dysfunction

41
Q

Tet spell

A

bluish skin during episodes of crying or feeding

  • children with TOF
  • pulling legs towards trunk
42
Q

Squatting

A

knee to chest position

  • improves oxygenation with children TOF
  • less travel for oxygenated blood
43
Q

Clubbing

A

normal: 160 deg
club: 180 deg

-not fully understood

44
Q

Nursing Management for CHDs that decrease pulmonary BF

A
  • tx hypercyanotic episodes (squatting)
  • provide post-op care
  • assess VS, pulse ox, perfusion, distal pulses
  • monitor I and Os
  • support families
45
Q

Mixed Defects

A
  • infant survival is dependent on mixing systemic and pulmonic blood
  • cause varying degrees of cyanosis and CHF
46
Q

Transposition of Great Arteries

A
  • parallel circulation (life threatening at birth)
  • pulmonary artery leaves the L ventricle and the aorta exits from the R ventricle
  • must have PDA or septal defect to permit BF
47
Q

clinical manifestations of transposition of great arteries

A
  • cyanosis
  • hypoxia
  • CHF
  • murmur
  • tachypnea
  • slow feeder
48
Q

Tx of TGA

A
  • infusion of prostaglandin E1 to maintain PDA
  • balloon atrial septostomy to enlarge foramen ovale (creates ASD)
  • Arterial switch (surgical) resect and reanastomose great vessels within first week of life
49
Q

Prognosis of TGA

A

survival impossible without surgery

-97% survival age 20

50
Q

Arterial switch

A
  • few complications

- many problems with old standards like arrhythmias

51
Q

Nursing Management of TGA

A
  • monitor prostaglandin therapy
  • tx hypercyanotic episodes
  • surgery by 1 week
  • support families
  • provide post op care
52
Q

Defects that obstruct systemic BF

A
  • increase workload on left ventricle of the heart, leading to decreased cardiac output
  • low CO leads to decreased pulses, decreased UO, sluggish cap refill
  • blood backs up into LA and then lungs (CHF)
53
Q

COA

A
  • coarctation of the aorta

- narrowing or constriction of the descending aorta, obstructing system blood flow

54
Q

clinical manifestations of COA

A
  • BP is higher in arms than in the legs***
  • weak femoral or pedal pulses***
  • weakness in the legs after exercise
  • systolic murmur

-constriction is progressive: 20-30 percent develop CHF by 3 months

55
Q

Clinical therapy for COA

A
  • NBs may need prostaglandins
  • may need to tx CHF before sx
  • repair: surgical repair preferred over dilation with balloon during cardiac cath
56
Q

prostaglandins

A

reopens ductus arteriosus and widens aortic arch

57
Q

Prognosis

A
  • coarct may reopen, persistent HTN is common

- lifelong followup required

58
Q

Common Diagnostic Tests

A
  • Echocardiogram
  • EKG/Halter monitor
  • Cardiac cath
  • CXR
  • CT
  • MRI
  • Exercise Testing
59
Q

3D MRI has…

A

replaced echo

60
Q

Common Lab Tests

A
  • ABG
  • CBC
  • Dig level
  • ASO titers
  • ESR, CRP
  • Serum lipids
61
Q

Nursing Care: Post op Open Heart Teaching

A
  • sternal precautions: do not lift child under the arms. one hand under the head and one hand under hips
  • car seat: protect incision with blanket
  • sponge bathe until steri-strips fall off
  • activity as tolerated, no rough play
  • no back packs
  • antibiotic prophylaxis if prosthetic heart valve
  • no live vaccines for 6 months if RBC transfusion
62
Q

Cardiac Catheterization

A
  • used to create atrial septostomy or dilate narrowing (balloon)
  • stent can keep PDA open
  • coil used to close PDA or other vessels
  • Pre-op may cancel for:
  • dental dz
  • resp illness
  • diaper rash
63
Q

Cardiac Cath Post op

A

Monitor for:

  • perfusion
  • bleeding
  • arrhythmia
  • infection
  • check under leg for bleeding
  • maintain pressure dressing for 4 hours
  • lie with leg straight for 6 hours may need leg board
  • assess dressing per order
64
Q

Rheumatic Fever

A
  • not congenital - acquired
  • inflammatory disorder of connective tissue after infection by Group A beta-hemolytic streptococci

(post strep throat)

-affects joints, skin, brain, serous surfaces, and heart

65
Q

Most common complication of RF

A

rheumatic heart disease

  • damage to valves as result of RF
  • may lead to permanent aortic or mitral valve damage
66
Q

Clinical Manifestations of RF

A
  • may appear 1-3 weeks after an untreated strep throat
  • heart: new murmur, carditis involving mitral or aortic valve, results in valve damage
  • joints: inflamed, painful
  • skin: rash with pink macules and blanching in the middle of the lesion (erythema marginatum)
  • brain: chorea
67
Q

chorea

A

aimless movements of the extremities, facial grimacing

68
Q

Diagnosis of RF

A
  • jones criteria
  • need evidence of preceding strep infection AND 2 major manifestations

OR

-1 major and 2 minor

69
Q

Major Manifestations for Jones Criteria

A
  • carditis
  • polyarthritis
  • chorea
  • rash
  • subq nodules
70
Q

Minor Manifestations for Jones Criteria

A
  • arthralgia
  • fever
  • increased ESR
  • increased CRP
  • prolonged PR interval
71
Q

Tx for RF

A

-antibiotics to eradicate strep infection

  • PCN G IM x1
  • PCN V oral x10 days
  • Sulfa oral x10 days
  • Erythromycin if allergic to above x10 days
  • ASA to tx carditis, joint inflammation, fever
  • steroids
  • long term AB prophylaxis
  • most children recover fully
72
Q

Nursing Management for RF

A
  • prevention, throat cultures, complete antibiotic regimen
  • tx of streptococcal tonsillitis/pharyngitis
  • monitor temp
  • BR
  • admin meds
  • home teaching
73
Q

Kawasaki Disease

A
  • acute febrile illness associated with systemic vasculitis
  • unknown etiology, more common in japanese
  • often preceded by an URI
  • serious complications include coronary artery dilation and aneurysms
74
Q

Diagnosis of Kawasaki Disease

A
  • clinically diagnosis
  • High fever over 39 C for 5 days or longer AND 4 out 5 of the following:
  • redness and edema of hands and feet, peeling of skin
  • dry, cracked lips, strawberry tongue, pharyngeal erythema
  • conjunctival redness without discharge
  • macular-papular rash on trunk and extremities
  • cervical lymphadenopathy
75
Q

Tx for Kawasaki Dz

A
  • IVIG (IV immunoglobulin) and ASA reduces the incidence for coronary lesions by 5%
  • standard therapy: a single dose of 2g/kg IVIG infused
  • acute phase: ASA is admin as an anti-inflammatory at 80-100 mg/kg/day Q6 hrs
  • once fever has resolved ASA is reduced to the anti-thrombotic dose of 3-5 mg/kg/day as single daily dose
76
Q

Nursing Management of Kawasaki Dz

A
  • assess heart sounds
  • admin meds
  • regulate IVIG infusion, watch for rxns
  • passive ROM for joint movement
  • promote comfort
  • home teaching
77
Q

Differences between Kawasaki Dz and RF

A

patho: KD is inflammatory process and RF is post strep infection
diagnosis: KD by fever and 4/5 criteria and RF by Jones Criteria

Tx: KD IVIG and RF antibiotics

Affects: KD affects coronary arteries and RF affects valves of the heart

78
Q

Surgical intervention is always necessary in the first days of life when an infant is born with…

A

Tranposition of the Great Arteries

-the one defect that needs it immediately

79
Q

An infant with teralogy of fallot is discharged with a Rx of lanoxin elixir…the nurse should instruct the mother to..

A

calibrated dropper

-digoxin questions, dangerous with small therapeutic window

Peds Exam 1 (6 decks)

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